Healthcare Manager Swallows Bitter Lean Pill and "Likes" It

A chance conversation uncovers a troubling, unhealthy perspective.

Last weekend I attended a social function where I had a chance to talk to a woman from a neighboring town who works for a large hospital and Healthcare services provider.

During our converstaion I recognized her position at the hospital as being a middle management role so I asked her if she new about "Lean" entering the Healthcare industry. She immediately new what I meant, told me her hospital was involved, and then quickly began describing a project impacting her area. The description she gave included a few details, all of which seemed technically correct. Based on what she said, the work seemed admirable and I am sure the hospital will realize good benefits from their efforts.

Then, just out of curiosity, and in the regular flow of the conversation, I asked how she felt about the new program. She replied almost matter-of-factly but with a bit of sarcasm clearly evident in her tone of voice. This is what she said,

"it doesn't matter what I think. Everyone knows they are supposed to smile and say how much they like it."

It took a little while for her answer to sink in. Later, when I recalled the candid comment, and details she mentioned indicating the leaders of the project were making an effort to ensure employee involvement, I couldn't help but think, "maybe the executive management team believes they have the strength of genuine employee involvement on their side, when in reality, what they really have is a weaker, artificial form of employee involvement."

Rescuing Lean

When Physicians See Lean as Unhealthy, Bad Medicine

A recent blog posting, Criticism of Lean at Park Nicolett Hospital, and the comments following the posting, brought out an important issue facing passionate Lean practitioners. I consider myself among this group. Check out the ninth comment below the posting - it appears to be from someone in the health care industry, possibly a physician, who has recently been part of a Lean deployment effort at a hospital. The commenter, who appears to be sincerely upset, sees Lean in a very poor light. For example, he made the following point which summarizes his thinking

"Running around with stop watches on a nursing floor and putting up charts about flow and such do not encourage "buy-in". Nurses and doctors are there to serve the patients. They do not view patients as part of an assembly line."

Clearly the commenter's viewpoint of "Lean" is negative and not a fair representation of "Lean", but, for all we know, may be legitimate based on the experience of how "Lean" was introduced into the hospital environment in question. To be fair, the commenter, who signed the comments as "anonymous", may represent a rare, outlier viewpoint not consistent with others at the hospital at all.

For the sake of discussion, let's suppose the following:

• the commenter is a physician who has been involved in a lean effort
• the implementation has missed the mark in a few ways; maybe
• the implementers relied too heavily on "tools and templates" and essential "Lean" management and "Lean" social aspects were absent
• project selection was not truly driven from the "bottom up"
• the effort advanced with physicians under-represented or otherwise not "on board"
• the physician now has a sincere, strong negative view of Lean
• the "physicians" as a group share this same negative view of Lean
• other groups still see "Lean" as good but the effort will not be nearly as strong as it could be without the physician "buy-in"

What is the approach you must take to rescue "Lean" in the eyes of the physicians?

Based on my experience in a variety of industries, the following must be done:

• take "Lean" back to its core meaning - principles and methods used to add or strengthen value
• review the cooperative nature of "Lean" - all stakeholder groups should see Lean as "good"
• use basic terms everyone agrees represent "good", for example "Lean" is about getting more of what you want and less of what you don't want
• discover value through the eyes of the physicians
• translate value, or "getting more of what you want", into the real world benefits the physicians agree they would like to see happen, for example, maybe they would like "more time with patients"
• list the issues and pick one near the top of the list to solve
• partner with the physicians to solve it or significantly improve it
• make "lean" principles and concepts part of the problem solving effort
• take only the time the participating physicians are willing to give based on the perceived value of the issue (in other words - don't waste their time)
• make your effort light on complicated tools and heavy on common sense, hard data, and real world experience
• work through implementation and beyond addressing all group concerns
• work thoroughly to put the changes in place as a system-based solution; one that will last
• verify the physicians as a group see the improvement as "as a better way"; one they will protect

Applying the above in the right way will correct the problem (the right way - common concern, common understanding, common goal, executive support, group agreement, group resolution, group benefit). Physicians as a group will now see "Lean" as good and will agree to contribute to the effort.

Moving forward, to keep the physicians "on board", the local deployment leader must tell the physicians to hold the "Lean" effort to the standard of "more of what you want and less of what you don't want". Explain the standard applies to the physicians as a group. The deployment leader will need the backing of executive management and the freedom to take corrective action when the standard "takes a hit". Correcting problems as they crop up along the way will demonstrate to the physicians their interests are being taken seriously and emerging problems are being quickly resolved to their satisfaction.

Applying the same standard and protocol to all stakeholder groups will keep all groups on-board and the effort moving forward with maximum benefit and minimum waste.

Choosing Which GM Dealerships to Close

A Difficult but Necessary Strategy to Deploy

How would you go about selecting the dealerships to shut down? My colleague, Dean Willson, has posted a well written potential scenario on his Practical Business Improvement blog - "One Strategy to Describe GM History in More than 11 Chapters"

Starting Off on the Right Foot

Approaching People about a New Idea in a Natural Way

As a consultant working to get a project off to a good start, or to improve some aspect of a project already underway, I come in initially as an outsider. I assume a temporary role as a deployment leader, or work closely with the local person filling that role.

Below is a sample conversation describing how I would introduce the deployment of an executive strategy to a front line employee. It nevers happens exactly like I present it here but I have tried to lay the main ideas out clearly enough. You'll recognize the "Catchball" technique and "A3 management ideas". In real life of course, discussions occur in a more natural back-and-forth way and may be more specific or even technical in nature depending on the circumstances.

(After introducing myself and stating I am representing a particular executive)

Deployment Leader: “I hear you, your team, and the rest of the people here do a great job, and lots of people depend on you for the products and services you provide them. You are part of an important company. I bet that makes you feel good.” (this is sincere - I wouldn't say it if it wasn't true - people would pick up on it and I would lose my chance to build honest rapport)

Front Line Employee: “Yes. It does.”

Deployment Leader: “Plenty of people around here have told me they feel the same way. The boss wants to keep that feeling here and make it better. He sees things are changing for your business, (insert relevant information here about the marketplace challenges), things that might get in the way if we don’t figure out how to respond – you know, with ways we can change things to stay out in front of the competition.

He’s got an idea about what he believes needs to happen and he asked me to explain it to you and then talk to you about it. He asked me to listen carefully to what you have to say because he wants what’s best and he said you know a lot about how this place works. My job at the moment is to explain his idea, listen to what you have to say, write down any concerns you have, and then come back later and talk to you about how we’ll work it out so your concerns are taken care of. It may take a little back and forth to get it right.

I’ll be doing the same with others in the organization so it will take some time. In a couple of weeks we’ll meet in larger group. By then our plan should be mostly worked out, and you will already know the main points, so our meeting will to go over the plan and take care of some final details.

What we are doing is important since it’s about the future of your company. Nailing down the best ideas for keeping this place strong, and figuring out how to put those ideas to work in ways we agree are smart, makes a lot of sense to me. Does it make sense to you?”
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Doing my homework beforehand so I know what the company does, who the customers are, and why they rely on the company I am working with is critical. I also need to know how the executive(s) in charge of the strategy sees things so I speak on their behalf in the right way. It does not take long but the prep work is important part of what must be done to help people see me as someone who is working a process designed to "get things right".

Let me know if you find these kind of 'more "real life" descriptions helpful.